The U.S. Attorney for the Southern District of California has issued an indictment and arrest warrant against Sam Solakyan, who headed numerous imaging centers in the state tied to fraud allegations. Solakyan allegedly paid $8.8 million in kickbacks for referrals, which were used to bill workers’ compensation payers for $284 million.

The California Division of Workers’ Compensation has dismissed almost 5,000 liens filed by companies associated with Michael R. Drobot, including Industrial Pharmacy Management and California Pharmacy Management. This marks the first major case involving a provision in AB 1244 which requires the DWC to dismiss liens held by individuals convicted of fraud.

On Thursday, a federal judge in Northern California ordered Pain Free Diagnostics Inc. to deposit the $1.2 million it owes in restitution to over 24 defrauded carriers. In an unrelated case, the U.S. Attorney’s Office for Southern California obtained a guilty plea from a doctor for accepting kickbacks for prescriptions and therapy.

Today, the California Supreme Court decided in King v. CompPartners that an injured worker’s claims against a utilization review (UR) doctor are exclusively compensable as part of the workers’ compensation system.

The California Division of Workers’ Compensation (DWC) has suspended 11 more medical providers from participation in the California workers’ compensation system. 274 total providers have been suspended thus far in 2018.

Dr. Jacob Tauber of Beverly Hills and Dr. Serge Obukhoff of Malibu have been indicted by a federal grand jury for participating in a kickback scheme involving referrals to Pacific Hospital of Long Beach, bringing the total cost of the scheme to almost $1 billion.

The California Division of Workers’ Compensation has announced the formation of the Pharmacy & Therapeutics Committee, which will consult with and advise the DWC on updates to the Medical Treatment Utilization Schedule Drug Formulary.

The California Department of Insurance has ordered that every insurer licensed to write workers’ compensation insurance in the state is required to report their yearly tax savings due to the tax Jobs and Cuts Act of 2017, beginning in 2018.

This week, federal prosecutors in Los Angeles indicted several medical providers, as well as an attorney, in numerous scams to defraud Medicare, private health insurers, workers’ compensation insurers and programs, and a military health insurance program.

Drs. Jeffrey Gross, David Payne, and Lokesh Tantuwaya have been charged with conspiracy and fraud for collectively receiving over $4 million in kickbacks for surgeries and referrals at Pacific Hospital in Southern California.

The California Division of Workers’ Compensation (DWC) has suspended 20 more medical providers from the state’s workers’ compensation system for fraud and related criminal actions, or for loss of license.

The Division of Workers’ Compensation (DWC) announced that it has suspended 12 more medical providers from the state’s workers’ compensation system. Nine of these providers were suspended for fraud or criminal actions, while three were suspended for administrative reasons. These suspensions bring the total number of medical providers suspended in California this year to 85. The following providers were suspended: Paul … Continued

The Division of Workers’ Compensation (DWC) announced that it has suspended another 21 medical providers from the state’s workers’ compensation system. A total of 73 medical providers have been suspended in California this year.

On September 14, 2017, 1200 Petitions for Reconsideration were filed by and through lien claimant Maximum Medical. These Petitions requested reconsideration of the enforcement of new lien assignment statutes, challenging an administrative action in the DWC’s Electronic Adjudication Management System (EAMS) that would have resulted in the automatic dismissal of liens due to an alleged failure to timely file declarations. The Appeals Board has consolidated the cases in its decision.

The California DIR’s Department of Workers’ Compensation (DWC) has suspended an additional 8 medical providers who were found guilty of fraud. Orders of Suspension from California’s workers’ compensation system were filed against the following medical providers: Abraham Khorshad – This Beverly Hills investor in Aspen Medical Resources was also a co-conspirator with providers Jeffrey Campau and … Continued

Three former qualified medical evaluators (QMEs) who were denied re-appointment are suing the Department of Industrial Relations (DIR) and its director Christine Baker for using “underground regulations” to deny them re-appointment.

The Court of Appeal, Third Appellate District, in City of Jackson v. WCAB (Rice) (4/26/17), has issued a decision that will provide substantial assistance in achieving the Legislature’s directive in Labor Code Section 4663 with respect to apportionment.

In a recent decision, the Workers’ Comp Appeals Board affirmed its prior decision in Aguilera v. Collins Chiropractic Group which said that a plaintiff’s industrial injury caused only 88% permanent disability rather than the 100% determined by the Workers’ Comp Judge.

When is a communication not information? Is there a distinction between the two or are there consequences from a failure to correctly categorize? The Workers’ Compensation Appeals Board, in its January 23, 2017 En Banc Decision in Maxham v California Department of Corrections, has provided the answers.

In Nunez v Petrochem Insulation, Inc, 2016 Cal. Wrk. Comp P.D. LEXIS, the Court was presented with a scenario which did not result in the achievement of the objective of the California Constitution, Article 16, that cases be resolved expeditiously, inexpensively and without encumbrance of any character.

On October 13, 2016, applicant attorney filed a Petition for Writ of Review to the 4th DCA in Parrent v. Workers’ Compensation Appeals Board/Pacific Bell Telephone Co. SBC, Case Number D071162, with the defendant filing an Answer on November 7, 2016.

The WCAB has issued several cases recently in which they essentially state that LC § 5814 does apply to the unreasonable delay/denial of supplemental job displacement benefits, but the penalty of up to 25% is only on the amount actually used by the applicant, not the entire amount.

In a split panel decision of Luna v. The Home Depot, the WCAB stated that the defendant’s MPN is valid even though it did not have three orthopedists within the applicable geographic radius to act as primary treating physician (PTP).

One of the hallmark provisions of the most recent statutory amendments to the Labor Code, Independent Medical Review (IMR) has generated much litigation and even more speculation as to its ramifications and ultimate constitutionality.

As noted above and in previous Quarterly Reviews, SB 863 continues to generate controversy, the California workers’ compensation community is still trying to make sense of UR/IMR and learn how to incorporate the basic process into their practice.

In State of California/Department of Corrections & Rehabilitation v. WCAB (Van Dyk) (2016) 81 Cal. Comp. Cases 458, Applicant had a specific injury to the lumbar spine, which settled. A CT claim was subsequently filed, alleging injury to his back and psyche.